Q&A: How are abortions carried out? Can a foetus feel pain?

It depends on a number of factors, including how far along the pregnancy is.

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In our Q&A: Eighth Amendment Referendum series, we are answering questions our readers have submitted in relation to the upcoming vote on 25 May.

THE QUESTION

I would like to know what the procedure involves…
Does the foetus feel pain?

THE ANSWER

THE TYPE OF abortion a woman or girl has depends on a number of factors.

As explained by the British Pregnancy Advisory Service (BPAS), which has been providing terminations for women and girls from Ireland since 1968, the type of abortion procedure a female has will depend on:

how many weeks pregnant she is
if she would like to be sedated
any medical conditions she may have

The Abortion Act 1967 requires abortion practitioners in the UK to obtain the signatures of two doctors before they can perform a termination.

Medical abortion

The abortion pill is used in the early stages of pregnancy through the use of two medications: mifepristone and misoprostol.

Mifepristone blocks the production of progesterone, the hormone that supports the pregnancy before the placenta is developed. Misoprostol then causes the uterus to contract, causing cramping, bleeding and the loss of the pregnancy in a similar way to a miscarriage.

Different doses are prescribed depending on the gestation of the pregnancy. Medical termination can be completed in a community or home setting before 12 weeks, with only occasional requirement for hospital facilities, BPAS states.

The abortion pill – up to 10 weeks of pregnancy

In this instance, medication is used to cause an early miscarriage (the female may experience cramping and heavy bleeding). She may need two visits to the clinic, which may be in one day (six hours) or up to three days apart. No surgery or anaesthetic is involved.

BPAS recommends that the woman or girl does not travel until the pregnancy has passed (90% of females will pass the pregnancy within four hours of taking the second medication).

Abortion pill – between 10 and 24 weeks of pregnancy

In this case, medication is used to make the womb contract and push out the pregnancy. From 22 weeks an injection to the womb may be required.

At least two visits to the clinic are required in this instance. Sometimes an overnight stay at the clinic is needed at the second visit.

Surgical abortion

BPAS describes surgical abortion as “a practical option for women needing to travel for treatment and most treatments (up to 20 weeks) need only one visit to the clinic”, which is often the case for women and girls travelling to the UK from Ireland.

Vacuum aspiration – up to 15 weeks of pregnancy

This removes the pregnancy via “gentle suction”. It can be done under local anaesthetic up to 12 weeks of pregnancy. The quicker recovery time for this procedure means women “can leave the clinic unattended and can drive sooner”, BPAS explains. It can be carried out under sedation up to 15 weeks of pregnancy.

Dilatation and evacuation – between 15 and 24 weeks of pregnancy

The pregnancy is removed using a narrow forceps through the neck of the womb. This procedure is carried out with sedation if the pregnancy is under 19 weeks, and with general anaesthetic if it’s over 19 weeks. Treatment undertaken at over 20 weeks may require more than one visit or an overnight stay, BPAS says.

“If you are travelling from Ireland we will try and arrange for your consultation and treatment on the same day – plan to be at the clinic for the whole day,” the organisation notes.

Does the foetus feel pain?

The Journal of the American Medical Association (JAMA) examined the issue in this study and said that “evidence regarding the capacity for fetal pain is limited” but added that “fetal perception of pain is unlikely before the third trimester”.

Explaining their conclusion, the authors say: “Pain is an emotional and psychological experience that requires conscious recognition of a noxious stimulus. Consequently, the capacity for conscious perception of pain can arise only after thalamocortical pathways begin to function, which may occur in the third trimester around 29 to 30 weeks’ gestational age, based on the limited data available.

Cutaneous withdrawal reflexes and hormonal stress responses present earlier in development are not explicit or sufficient evidence of pain perception because they are not specific to noxious stimuli and are not cortically mediated.

Speaking in more lay terms on RTÉ’s PrimeTime on 15 May, Professor Paula Murphy – a developmental biologist who specialises in embryonic and foetal development – explains, “Up to 24 weeks, it’s not possible for any awareness or pain sensation even though the nervous system is being constructed.

“Some people point to reflex responses in the foetus before that – a foetus will respond to touch – but this is a spontaneous reflex that is controlled through the spinal cord, not through the front of the brain where awareness would be recorded.”

More information about the different types of abortion procedures can read here.

With reporting by Sinéad O’Carroll

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